The Washington Post on Tuesday examined HIV/AIDS outreach efforts aimed at African immigrants in the U.S. According to the Post, some health researchers say that the "message" that HIV/AIDS also affects Africans in the U.S. is "growing in importance as they become increasingly concerned that the AIDS epidemic ravaging sub-Saharan Africa is following migrants from that continent to America."

Local studies conducted across the U.S. have found "greatly disproportionate" HIV/AIDS rates among Africans, and health care providers in the Washington, D.C., area are recording similar trends, the Post reports. However, many providers are encountering a similar problem in that because many health departments do not ask patients where they were born, most HIV-positive African immigrants are categorized in surveys as "black" or "African-American."

"Quite frankly, many providers don't distinguish between Africans and African-Americans," Garth Graham, deputy assistant secretary for minority health at HHS, said. He added, "It doesn't take into account the different cultural backgrounds and perceptions of wellness and disease that these individuals have ... that's one of the glaring challenges that we're facing."

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Other health care providers say that the issue is compounded by stigma, language barriers and fears over deportation. Some immigrants are not familiar with the concept of preventive medicine and do not realize that an early HIV diagnosis can improve survival changes, according to providers. "You have to be sick to go to the doctor in Africa," Ashenafi Waktola, a district-area physician who was born in Ethiopia, said, adding, "That is disastrous with AIDS."

According to the Post, there are no "precise" national data about HIV/AIDS among African immigrants. However, studies conducted in places such as Minnesota and the Seattle area, which have relatively large African immigrant populations, have found much higher HIV/AIDS rates among Africans. Studies in Canada and Europe have found similar results, the Post reports. In the district area, information on country of origin "varies so much by jurisdiction and is so spotty that it provides only a blurry snapshot," according to the Post. However, a recent district Health Department survey conducted among groups that provide HIV/AIDS services to impoverished populations in the region found that 10% of those clients were born in Africa.

In addition, of the 31,256 AIDS cases reported in Maryland through September 2007, African immigrants accounted for 716, or 2.3%, of the cases -- slightly higher than their percentage of the population, which is about 2%. In Montgomery County, Md., 392, or 15%, of all reported AIDS cases were among Africans, who account for about 4% of the population. According to officials with Maryland's AIDS Administration, they are unsure how to explain the disparity between the Montgomery County and statewide data because reporting about country of origin by health providers is "often inconsistent or incomplete," William Honablew, an administration spokesperson, said. Other officials said that it is possible that health providers in Montgomery more routinely offer HIV tests to immigrants and record country of origin data more reliably. According to Honablew, the large majority of AIDS cases among African immigrants in Maryland have been recorded in Montgomery and Prince George's counties, and the AIDS Administration is planning an HIV program targeting African communities in those counties.

In Virginia, country of origin was recorded in 26% of the 1,062 new HIV cases reported in 2006, according to the state Department of Health. African immigrants, who account for less than 1% of the population in the area, accounted for 5% of all 1,062 newly recorded cases. According to the Post, African immigrants "almost certainly would account for a higher share if national origin were consistently recorded." According to a study conducted by a Seattle-King County epidemiologist, African immigrants in 2003 and 2004 accounted for at least 13% of the 639 new HIV infections in nine Northern Virginia counties.

Many health care providers and researchers said they believe that most HIV-positive immigrants contracted the virus in their homelands in part because the virus is diagnosed in the later stages in many cases. Because few educational materials aimed at African immigrants are available, outreach workers sometimes use materials written for U.S.-born blacks that have little cultural relevance for Africans, the Post reports. In addition, stigma often presents a large obstacle. Because African immigrant communities are "segmented and tight-knit," providers say that African immigrants "fear they would know a doctor or interpreter from the same community and that word of their condition would spread," according to the Post (Brulliard, Washington Post, 9/2).

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